Letters|1 December 1993

When and Whom To Screen

My editorial accomplished its purpose to generate vigorous debate about screening. The large benefit of treating diseased patients should not be confused with the exquisitely small benefit of screening patients who are very unlikely to have disease. In contrast to neonatal screening programs for phenylketonuria [1, 2], screening for ovarian cancer is not without risk. Follow-up transvaginal sonography may be uncomfortable, and exploratory laparotomy will produce some complications; both will consume scarce health care resources.

As Drs. Feagin and Burris note, clinicians care for individuals, but we often use average data about populations to estimate prognosis. Even acknowledging variation, a well-controlled series is substantially better foundation for clinical care than is personal experience or a case report. Although some physicians are troubled if we use averages in models to project future or expected benefits and risks, the point is that they are more stable and make better projections!